©2012 international medical corps isiolo smart survey may 2012 validation report from relief to...

©2012 International Medical Corps

Isiolo SMART surveyMay 2012

Validation Report

From Relief to Self-Reliance

Monitoring and EvaluationAnastacia Maluki

[email protected]

All content in this document is the property of International Medical Corps and should not be reproduced without prior written consent. This material is protected by copyright. ©2012 International Medical Corps. Materials may not be reproduced without International Medical Corps’ prior written consent.


BACKGROUND INTRODUCTION

• Isiolo district is in Eastern Province of Kenya and covers an area of 25,605 Km2

• Isiolo is classified as 100% ASAL• The survey area covered 5 administrative divisions of Isiolo

District namely: – Isiolo East, Central , Ol donyiro, Merti and Cherab

• Estimated total population of 104, 223 inhabitants, with an annual growth rate of 3.6% p.a.– The estimated Under-5 target population of the survey is

15.4% • The district receives a bimodal rainfall :

– short rains, which are most reliable, in mid-October to December while the long rains in mid-March to June


Map of Isiolo District


Rationale for conducting a survey

• To gauge the performance of the HINI package.

• Inform future programming in the district.• To evaluate the extent and severity of

malnutrition among children aged 6-59 months.

• Analyse the possible factors contributing to malnutrition .

• Recommend appropriate interventions.


Objectives • To estimate the current prevalence of acute

malnutrition in children aged 6-59 months and to compare the overall nutritional changes with previous GAM and SAM

• To estimate the retrospective crude and under five death rates and morbidity among under five children and as well compare with previous CMR and U5MR.

• To estimate Measles, BCG vaccination and Vitamin A supplementation for children 9-59 months and 6-59 months respectively


Objectives (2) • To assess the current food security situation of the

surveyed population, prevalence of some common diseases (Diarrhea, Fever, and Cough) and to identify factors likely to have influenced malnutrition in young children

• To assess child and infant care and feeding practices among caretakers with children 0-23 months

• To establish the situation of water and sanitation, appropriate hygiene practices including hand washing among caretakers


.

Methodology Anthropometric and MorterlityData entered on ENA software Anthropometri

c sampleRetrospective Mortality sample Rationale

Estimated prevalence 15.7 % 0.12INTEGRATED HEALTH AND NUTRITION SMART SURVEY ISIOLO DISTRICT, April

2011

Desired precision 4 0.3 Decided in conjunction with the Estimated Malnutrition prevalence of 15.7%

Design effect 1.5 1.5 anticipate malnutrition prevalence is quite different in the 5 divisions

Recall period 90 days it gave reasonable level of precision and an estimate that is close enough to the current situation. Recall period since 2nd Feb, 2012

Average household size 5.5 5.5INTEGRATED HEALTH AND NUTRITION SMART SURVEY ISIOLO DISTRICT, April

2011

Percent of under five children 14.8 Current Population estimates from DSO Office- Isiolo

Percent of non-respondent 3 3 Anticipate low level of non-response as there are no major events taking place / displacement/ conflicts

Households to be included 702 174

Children to be included 519

Population to be included 929


Methodology –IYCN (2)• Indicators calculated were:

– Timely initiation of breastfeeding (children 0-23 months),– Exclusive breastfeeding under 6 months, – Timely complementary feeding, – Minimum dietary diversity, – Minimum acceptable diet, – Minimum meal frequency and – continued breastfeeding at 1 year.

• The sample size for children between 0-23 months was 546 • The number of children reached per cluster was given by

dividing 546 by 36 giving 16 children per cluster.• Where children below 6 months were not found purposive

sampling was applied to get them.


Description of sampling methods

• Number of clusters to be surveyed was 36 =(702/ 20 (Household to be reached per day))

• A total of 6 survey teams :– 1 team leader – 3 enumerators

• Data was collected for 6 days (36/6).


Data collection Tools

• Questionnaire A (Household) - primary caretakers

• Questionnaire B (anthropometry ) – 6-59 months

• Questionnaire C (IYCF) - 0-23 months • Questionnaire D (Mortality) - all HH members • Focus Group Discussion (FGD) guide -

qualitative data.


Training• The team was trained for 3 days (14th-16th May,

2012):– nutrition survey objective– anthropometric measurements– interviewing techniques– completion of questionnaires– standardization test was done

• pre-test was done on 17th May 2012• Data collection begun on the 18th May, 2012–

23th, April, 2012.


Data Entry and Analysis

• SMART/ENA for Anthropometric and mortality data analysis.

• All the other quantitative data was entered and analyzed in the SPSS (Version 15.0) computer package


Findings: Demographic CharacteristicsDEMOGRAPHY Number

Number of HH surveyed 700

Number of children 6-59 months surveyed 704

Number of children 0-23 months surveyed for IYCN 554

Average number of persons per HH 5.9 S.D = 2.5

Average number of children (0-6 months ) per HH 0.2 S.D=0.4

Average number of children (6-59 months ) per HH 1.2 S.D = 0.8

Most of the children aged 0-23 months for IYCN were not included in the anthropometric measurement. They were purposively sampled.


Distribution of age and sex of 6-59 months.

• overall male: female ratios were within the expected range of 0.8 – 1.2

• 21% of children aged 0-23 were purposively sampled for IYCN indicators this explains why there are more children in the age category 6-17 months.

Boys Girls Total Ratio

AGE (months)

no. % no. % no. % Boy:girl

6-17 100 42.0 138 58.0 238 33.8 0.7

18-29 97 63.0 57 37.0 154 21.9 1.7

30-41 69 44.8 85 55.2 154 21.9 0.8

42-53 67 58.3 48 41.7 115 16.3 1.4

54-59 24 55.8 19 44.2 43 6.1 1.3

Total 357 50.7 347 49.3 704 100.0 1.0


Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex

Boys were more malnourished than girls but it was not significantly. P value for the GAM rate was 0.842

Alln = 699

Boysn = 353

Girlsn = 346

Prevalence of global malnutrition (<-2 z-score and/or oedema)

(77) 11.0 %(8.5 - 14.2 95% C.I.)

(46) 13.0 %(9.6 - 17.5 95% C.I.)

(31) 9.0 %(5.9 - 13.4 95% C.I.)

Prevalence of moderate malnutrition (<-2 z-score and >=-3 z-score, no oedema)

(53) 7.6 %(5.7 - 10.0 95% C.I.)

(29) 8.2 %(5.4 - 12.3 95% C.I.)

(24) 6.9 %(4.7 - 10.1 95% C.I.)

Prevalence of severe malnutrition (<-3 z-score and/or oedema)

(24) 3.4 %(2.2 - 5.3 95% C.I.)

(17) 4.8 %(2.9 - 7.8 95% C.I.)

(7) 2.0 %(0.9 - 4.7 95% C.I.)


GAM 3.8%

Prevalence of acute malnutrition based on MUAC cut off's and/or oedema

Nutritional Status MUAC Criteria Number Percentage2012

Percentage2011

Severe malnutrition <11.5cm 4 0.5% 1.4%

Moderate malnutrition >=11.5 and <12.5cm

27 3.8 % 3.4%

At risk of malnutrition >=12.5 and <13.5cm

117 16.6% 17.3%

Satisfactory nutritional status >=13.5cm 556 79 % 77.5%

TOTAL 704 100% 100%


Prevalence of underweight based on weight-for-age z-scores by sex

Boys are more underweight than girls and this is significant. P. value =0.0126

Alln = 696

Boysn = 351

Girlsn = 345

Prevalence of underweight(<-2 z-score)

(116) 16.7 %

(13.7 - 20.2 95% C.I.)

(73) 20.8 %(17.1 - 25.1 95% C.I.)

(43) 12.5 %(8.8 - 17.4 95% C.I.)

Prevalence of moderate underweight(<-2 z-score and >=-3 z-score)

(100) 14.4 %

(11.7 - 17.5 95% C.I.)

(61) 17.4 %(14.1 - 21.2 95% C.I.)

(39) 11.3 %(7.8 - 16.1 95% C.I.)

Prevalence of severe underweight(<-3 z-score)

(16) 2.3 %(1.3 - 4.1 95% C.I.)

(12) 3.4 %(1.8 - 6.3 95% C.I.)

(4) 1.2 %(0.4 - 3.1 95% C.I.)


Prevalence of stunting based on height-for-age z-scores and by sex

Boys are more stunting than girls and this is not significant. P. value =0.281

Alln = 689

Boysn = 348

Girlsn = 341

Prevalence of stunting(<-2 z-score)

(118) 17.1 %(14.7 - 19.9 95% C.I.)

(71) 20.4 %(16.3 - 25.3 95% C.I.)

(47) 13.8 %(10.4 - 18.0 95% C.I.)

Prevalence of moderate stunting(<-2 z-score and >=-3 z-score)

(91) 13.2 %(10.9 - 15.9 95% C.I.)

(50) 14.4 %(10.9 - 18.7 95% C.I.)

(41) 12.0 %(8.7 - 16.5 95% C.I.)

Prevalence of severe stunting(<-3 z-score)

(27) 3.9 %(2.6 - 5.8 95% C.I.)

(21) 6.0 %(3.8 - 9.4 95% C.I.)

(6) 1.8 %(0.8 - 3.6 95% C.I.)


Comparison of GAM rates in Isolo

There has been good short rains which was experienced in the late 2011 which has led to improved pasture and livestock productivity . Kidding and lambing has also improved milk availability and food availability has also improved. This also followed BSFP interventions (Sept 2011-Feb 2012), out reaches have helped in reaching malnourished cases in far to reach areas. .OJTs enhanced capacities of health workers and CHWs in active case finding.

May 2012

(95% C.I.)

April 2011

(95% C.I.)

interpretation

Prevalence of global malnutrition (<-2 z-score and/or oedema)

11.0 %(8.5 - 14.2 )

15.7% [12.0 - 20.2]

No Difference

Prevalence of moderate malnutrition (<-2 z-score and >=-3 z-score, no oedema)

7.6 %(5.7 - 10.0 )

13.1 %[9.6 - 17.5 ]

No difference

Prevalence of severe malnutrition (<-3 z-score and/or oedema)

3.4 %(2.2 - 5.3)

2.6% [1.8 - 3.7]

p.value=0.0072 (significant)


Nutrition Status of caregivers of < 5 year old children: n=676

The main cause of maternal malnutrition was lack of balance diet and enough food especially for the pregnant and lactating mothers.

pregnant lactating Not pregnant and lactating Total0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

9.6%

7.4%

8.5%

7.8%

Maternal MUAC <21cm


Vaccination coverage Measles

n=644 OPV 1n=704

OPV 3n=704

Deworming (12-59 Months)N=587

YES

with cardn=468

With Recall from mothern=144

with cardn=530


with cardn=509


with cardn=266


% 72.7 22.4 75.3 22.4 72.3 23 45.3 32.3

Overall %

(2012)

95.1 97.7 95.3 77.6

Overall % 2011

91.4 96.4 94.3 41.0

Vaccination coverage was above National coverage of 80% except for deworming .Improved deworming attributed to improved HINI interventions through outreaches and creating awareness through M2MSG.


Vitamin A coverageVitamin A 6-59 months N=704

Vitamin A 6-11 months N=117

Vitamin A 12-59 months ( received twice in the last 1 year)N=587

90.8% 92.3% 41.9 %

56.3% (2011)

Vitamin A supplementation has improved through HINI interventions which are done through outreaches and OJT


Symptom breakdown in the children in the two weeks prior to interview (n=428)

60.8 % of the under-fives reported to have been sick. Majority (55.4%) of the HH reported seeking medical assistance for their sick child.

48.8%

23.2%

10.3%

6.6%

3.8%

2.8% 0.9% 0.5%

3.1%Cough

Malaria

Water Diarreah

Stomache

Eye Infection

Skin infections

Measles

Blood Diarrohea

Others


Zinc Supplementation during Last DD EpisodeManagement of last DD Episode (N=46) %

Oralite/ORS /Zinc 10.7

Home-made salt/sugar solution 6.5

Nothing 82.6

Low usage of zinc is because of shortage supply of zinc to the government hospitals


General and Domestic House hold water sources n=700

it takes an average 41.4 minutes to access main source of water and HH use an average of 80.1 litres of water per day.

Tap Water River Laga Borehole Unprotected well

Protected well others Lake Public pan0%

10%

20%

30%

40%

50%

60% 56%

20%

13%

4% 3% 2%1% 0% 0%


Methods of Water treatment

68% of those who don’t treat water get water from safe sources ( tap water and protected well).

Nothing Add Chemicals Boiling Use traditional herbs0%

10%

20%

30%

40%

50%

60%

70%66%

23%

10%

1%


Frequency of meals taken in household

meal frequency taken 2.6 (SD 0.7) On average the mean Individual Diet Diversity Score was 4.1 (SD 1.6) for the number of food groups consumed

1 2 3 4 50.0

10.0

20.0

30.0

40.0

50.0

60.0

8.0

34.6

52.9

3.61.0

11.7

36.4

47.9

2.91.1

Usual mealsPreceeding survey

Meal frequency

percentage


HOUSEHOLD DIETARY DIVERSITY SCORE (HDDS)

Diet Diversity Groups May 2012 % April 2011 %

Low Diversity Groups (<=3 food groups)

35.4 16.0

Medium Diversity Groups (4-5 food groups)

48 60.9

High Diversity Groups (>6 food groups)

16.5 23.2

With cereals being highly consumed (23%) and fish and sea (0.8%) products being least consumed.


Maternal Health Care n=700

With a mean of 3.6 ANC visits. Despite the high ANC attendance only 37.7 % of mothers deliver at hospital. It takes a mean of 77 minutes to get to the nearest health facility.

yes no Mother never delivered0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

94%

5%0%

Ante-Natal Clinic Visits

92.5% ANC attendance 39.7% hospital delivery. (2011 survey)


MORTALITY

May 2012 April 2011

CMR (total deaths/10,000 people / day

1.15 (0.52-2.42) (95% CI) 0.12(0.05-0.29 95%cl)

U5MR (deaths in children under five/10,000 children under five / day

0.62 (0.26-1.48) (95% CI) 0.27(0.07-1.08 95%CL)

Main cause of death among the > 5 years was that people were killed 28%. For Under 5 years was ARI 25%, Neonatal death 25%, During delivery 25% and unknown 25%


Summary of findingIndicators % 2012 % 2011Timely initiation of breastfeeding (children 0-23 months) (n=552)

77.5% 75.5

Exclusive breastfeeding under 6 months (n=170) 76.5% 58.5Minimum dietary diversity (6-23 months) Consuming 3+ food groups (breastfed children) (n=335) n=221

66%

Consuming 4+ food group (non-breastfed children) (N=46) n=22

48%

Consuming 3+ or 4+ food group (breastfed and non-breastfed children) (n=381) n=243

64%

Minimum meal frequencyAt least twice a day for 6-8 months (breastfed children) (n=75)

81%

3+ times a day for 6-23 months old (breastfed children) (n=335)

67%

4+ times a day of children 6-23 moths (non-breastfed children) (n=46)

17%

Minimum meal frquency N=381 n=232 61%

Toilet coverage (n=700) 56.7% 52.2%% of caregivers wash hands with soap+water (n=700)

76.4%


Plausibility checkIndicator Survey value

Acceptable value/range

Interpretations/Comments

Digit preference score - weight 5 <10 Excellent

Digit preference - height 5 <10 Excellent

WHZ ( Standard Deviation) 1.08 0.8-1.2 Good

WHZ (Skewness) -0.21 -1 to +1 Excellent

WHZ (Kurtosis) -0.06 -1 to +1 Excellent

Percent of flags WFH 0.7 % <3% Excellent

Overall Survey Score 11%

Age distribution (%)

Group1 6-17 mo33.8 % 20%-25%

Group 2 18-29 mo 21.9 % 20%-25%

Group 3 30-41 mo 21.9 % 20%-25%

Group 4 42-53 mo16.3 % 20%-25%

Group 5 54-59 mo6.1 % Ard 10%

Age Ratio : G1+G2/G3+G4+G5 1.26 Ard 1.0

Overall Sex Ratio 1.03 0.8-1.2 Excellent


Conclusion

• Decrease in GAM rates from 15.7% to 11.0% this was greatly influenced by good short rains which was experienced in the late 2011 which has led to improved pasture and livestock productivity . Kidding and lambing has also improved milk availability and food availability has also improved. This also followed BSFP interventions (Sept 2011-Feb 2012), out reaches have helped in reaching malnourished cases in far to reach areas. .OJTs enhanced capacities of health workers and CHWs active case

• Formation of mother-mother support groups from 4- 181 has increased IYCN components. EBF from 58% to 76.5%.

• Continuous OJT for health workers and community health worker has greatly improved HINI components especially for Vitamin A (56.3% 2011-90.8% 2012) supplementation and deworming (41% 2011-90.8% 2012).


Conclusion

• Decrease in food diversity was attributed to poor and damaged roads which lead to increase in market food prices and thus poor access to food.


Recommendations.

• Strengthen Community Led Total Sanitation and community awareness to increase toilet usage cover. 56.7% of households have access to toilet.

• Emphasis on the usefulness of hospital deliveries through mother to mother support group.

• Facilitate supply of zinc supplementation in the government hospitals.• Improve coverage and reporting in deworming • Treatment of drinking water through boiling. 66% of household reported

that they do not treat water.• Training of the community on appropriate hand washing. Only 76.4% of

responded reported to wash hands with soap and water.• Constitution of balanced diets using locally available foodstuffs (with

continued agricultural diversification). 54.9 % of the children samples consumed low dietary diversity of less than four groups

• Infrastructural improvement to improve access to markets and facilitate general development in all areas of the County

©2012 international medical corps isiolo smart survey may 2012 validation report from relief to...

Documents

isiolo east

km2 isiolo

survey area

young children

influenced malnutrition

severity of malnutrition

current situation

integrated health